No 1 (2014)

Since the 1980s, improved prenatal diagnosis and animal studies have led to the rapid development of fetal surgery. Despite fetal surgery’s advances in the treatment of complications of monochorial multiple pregnancy, no progress in congenital diseases, such as myelomeningocele and hydrocephalus, has been achieved at this stage. Whether intrauterine procedures for other abnormalities are expedient is discussable because of few observations described in the literature, undetermined patient selection criteria, and no randomized clinical trials. These congenital diseases include diaphragmatocele, congenital heart diseases with valve obstruction, obstructive lesions of the lower urinary tract, and sacrococcygeal teratoma. The complexity of the problem and possible complications are limiting factors in the extensive introduction of intrauterine operations into daily practice. Today fetal surgery is a reality, but requires that investigations of the efficiency and safety of the proposed interventions should be continued.

The paper discusses luteal phase (LP) defect in controlled ovarian hyperstimulation cycles: the causes and mechanisms of LP defect and the impact of different LP support regimens using progesterone preparations, human chorionic gonadotropin, estrogens, or a gonadotropin-releasing hormone (GnRH) agonist on the results of an in-vitro fertilization program. It gives data on a novel combined LP management regimen (with a GnRH agonist and micronized progesterone). The paper discusses the efficiency of this regimen versus the standard LP support regimen and the possible mechanisms of action of GnRH agonists on the endometrium, embryo, and corpus luteum.

Objective. To elaborate criteria for predicting the development of intrauterine infection (IUI) in neonates on the basis of comprehensive clinical, immunological, and molecular genetic examinations of pregnant women with placental insufficiency (PI). Subject and methods. Two hundred and eighty-seven patients with PI underwent a prospective examination involving a study of the phagocytic activity of neutrophil granulocytes and determination of the serum levels of cytokines and the distribution of alleles and genotypes at polymorphic loci in the mothers and their newborn infants. Results. The inverse correlation of the high level of induced production of reactive oxygen species in the maternal venous blood and their low generation in the neonatal umbilical cord blood is a predictor of IUI. The latter more frequently develops in babies born to mothers with the T/T genotype of IL8-251 AT gene polymorphism (OR = 2.6 (12-5.8), p = 0.022), which allows the determination of this polymorphism to be used as a predictor for IUI. The A/A genotype of IL10-592 A>C IL-10 gene polymorphism in a baby is associated with the increased probability of IUI in PI, chronic hypoxia, andfetal growth retardation during pregnancy (OR = 18.9 (1.7-215.2), p = 0.031). Conclusion. The findings permit early genetic screening to be used both among pregnant women forming a group at high risk for PI and IUI and among their neonatal infants.

Objective. To study the species and quantitative composition of lactobacilli in women with nonspecific vaginitis and bacterial vaginosis and to evaluate its impact on local vaginal immunity. Subject and methods. Real-time polymerase chain reaction was used to examine 377 reproductive-aged women: 157patients with nonspecific vaginitis, 46 with bacterial vaginosis, and 174 apparently healthy women. Results. The lactoflora was shown to most frequently contain 4 Lactobacillus species: L. crispatus, L. iners, L. jensenii, and L. gasseri. In the control group, the lactoflora displayed a preponderance of L. crispatus. Nonspecific vaginitis and bacterial vaginosis were accompanied as part of the lactoflora by the higher percentage of L. iners and L.gasseri, respectively. The predominance of L. iners affected local immunity. Conclusion. The larger number of L. iners and L. gasseri as part of the lactoflora was associated with vaginitis of varying etiology and bacterial vaginosis.

Objective. To evaluate the efficiency of compression sonoelastrography in the diagnosis and staging of endometrial cancer. Subject and methods. Forty-two patients with the verified diagnosis of endometrial cancer were examined. Preoperatively, all the patients underwent ultrasound study using an ultrasound compression sonoelastography procedure on a Hitachi Hi Vision Preirus with an endocavity transducer, 8-4 MHz frequency. The improved and adapted classification of elastographic types (types 1-3, benign; types 4-5, malignant) in gynecology was used to determine the degree of tissue density. The results of ultrasound study with elastography were compared with histological data. Results. The sensitivity and specif icity of sonography in the diagnosis of endometrial cancer were 87.8% and 86/9%, respectively. Conclusion. Inclusion of static elastography in comprehensive ultrasound study considerably enhances its informative value in the diagnosis of endometrial cancer.

Objective. To reveal the regional features of the etiological pattern of infertility in women from a northern region (in case of the town of Syktyvkar) versus a central one (in case of Belgorod and its region). Subject and methods. An open-label randomized controlled trial recruited 201 reproductive-aged women living in Syktyvkar and 109 women in Belgorod and its region. The women were divided into two groups: a control group of 40 healthy Syktyvkar women with a normal menstrual cycle, regular ovulation, and succeeding-year pregnancy. A comparison group was divided into two subgroups: 1) 85 Syktyvkar women and 45 Belgorod women who had anovulatory infertility and 2) 76 Syktyvkar women and 64 Belgorod women who had tubal or male factor infertility without anovulation. All the women underwent gynecological, clinical, anamnestic, hormonal, ultrasound, instrumental, radiological examinations, as well as studies of the endometrial biopsy specimens and spermogram of their sexual partner (husband). Results. The higher rate of infertility caused by endocrine disorders was noted in Syktyvkar. The levels of prolactin, testosterone, 17-hydroxyprogesterone and cortisol were considerably higher in the infertile women of Syktyvkar than in those of Belgorod without these differences being found in cortisol and testosterone levels between the women without anovulation. Hyperprolactinemia observed in the northern women was found to result from the higher rate of hypothyroidism or pituitary tumor processes. Conclusion. Hypercorticism in the infertile Syktyvkar women may be associated with the frequent exposure to cold stress while hyperandrogenism is likely to be due to the impact of seasons with long and short daylight hours. The reasons for the increased rate of hyperprolactinemia in the women of the northern region versus those from Belgorod remain unclear at this moment and require further investigation. It is apparent that the increased likeliness of anovulation due to hyperprolactinemia, hyperandrogenism, and hypercorticism should be borne in mind when elaborating prevention recommendations and when diagnosing and treating infertility in Syktyvkar women.

Objective. To evaluate the thyroid status in relation to the duration of iodine intake in pregnant women with autoimmune thyroiditis living in iodine-deficient areas. Subject and methods. A group of 64 pregnant women with autoimmune thyroiditis was examined. The thyroid status (the levels of thyroid-stimulating hormone, free thyroxine, antithyroperoxidase and antithyroglobulin antibodies, thyroid ultrasound characteristics) was studied in patients after early and late iodine prevention. Results. The early and late iodine prevention groups showed no significant differences in the changes of the thyroid status in patients with autoimmune thyroiditis during pregnancy. The trend was toward a less need for L-thyroxine replacement therapy among the pregnant women who had early iodine prevention. Conclusion. Intake of physiological iodine doses during pregnancy not only fails to have a negative impact on the activity of an autoimmune process, but also contributes to more stable thyroid function in patients with autoimmune thyroiditis both during pregnancy and the postpartum period.

The paper describes a clinical case of posterior reversible encephalopathy syndrome (PRES) caused by hypertensive encephalopathy and acute uremia during labor. It is shown that magnetic resonance imaging used in clinical signs of preeclampsia or eclampsia can reveal central nervous system lesion, evaluate the severity of a lesion, and assess the need for urgent delivery, as well as objectively monitor convalescence and the efficiency of performed therapy in the postpartum period.